E. coli from contaminated water or food, for example, is resistant to many drug types in regions around the world. But India has the highest rates of resistance to nearly every drug available to treat it. Strains of E. coli tested in labs there were more than 80 percent resistant to three classes of drugs, and treatment options there are increasingly limited, the report found.

Resistance to other antibiotics in bacteria like E. coli is also high, in some cases over 80 percent. “India has a perfect storm,” says Laxminarayan, including high background rates of infectious disease plus a large pharmaceutical industry plus an increasingly affluent population that can afford antibiotics. “You put all the things together and it’s this gigantic petri dish of experimentation that is resulting in highly pathogenic strains.”

MRSA, a dangerous staph infection often contracted in hospitals that does not respond to many antibiotics, is found at high rates in the United States, Romania, Portugal, Vietnam and India — rich, middle-income and poor countries alike.